Evaluating the Reliability of Cytological Analysis in Diagnosing Malignant Pleural Effusions: Challenges and Implications

Malignant pleural effusions (MPE) have huge implications for clinical practice and healthcare systems, affecting roughly one million patients annually. They are commonly associated with metastatic malignancies, leading to severe dyspnea and reduced quality of life. This study aimed to evaluate the reliability of cytological analysis for detecting neoplastic pleural involvement. Over a one-year period, a case-control study was conducted involving 151 patients, 79 of whom had confirmed malignant pleural pathology. Among the cases with positive cytology, 95.7% were diagnosed with pleural carcinomatosis, demonstrating the high specificity of the method. However, false-positive results and a high rate of false negatives were noted, reflecting challenges in sample collection, interpretation, and cellularity. Results indicate that cytological analysis is a valuable diagnostic tool, particularly for adenocarcinoma, with sensitivity rates as high as 89.9%. Nonetheless, the method is less effective for mesothelioma and other malignancies. Morphological features of pleural punctates, including turbidity and coloration, were shown to enhance diagnostic accuracy, while CT evidence of pleural thickening reduced sensitivity. The study highlights the critical need for improved sampling techniques and the integration of complementary diagnostic methods to mitigate false-negative rates and enhance reliability.